Objective Psoriatic arthritis (PsA) is a chronic inflammatory disease affecting the musculoskeletal system. This study aimed to compare the gender, clinical and radiological characteristics between PsA patients with age of onset ≥ 50 years (late-onset) and patients with age of onset < 50 years (early-onset), and analyze the correlation between age onset and disease features. Methods A retrospective cohort study of 281 PsA patients from Peking University People’s Hospital (2014–2022) was conducted. Demographic, clinical, laboratory, imaging and treatment data were collected. Comparisons between groups were performed using Student’s t-test, Mann–Whitney U test and chi-square test. Logistic regression described the association between age of onset and disease characteristics. Results Among the 281 cases (207 early-onset vs74 late-onset), there were more female in the late-onset group and more male in the early-onset group (60.8% vs 39.2%, 53.1% vs 46.9%, P = 0.039). The onset of PsO was later (44.22 ± 3.79 vs 27.43 ± 1.45, P < 0.001) and duration from PsO to PsA was longer (17.39 ± 14.78 vs 8.37 ± 7.82, P < 0.05) in late-onset group. The late-onset group has a higher proportion of polyarthritis (66.7% vs 50.5%, P = 0.019) and comorbidities, but a lower proportion of psoriasis (89.2% vs 97.1%, P = 0.019). Besides, the late-onset patients presented higher levels of ESR, folate and tartaric acid phosphatase (trap-5b), but lower levels of hemoglobin and homocysteine. Imaging features revealed more frequent X-ray bone destruction (40.7% vs 25.3%, P = 0.033), synovitis (81.0% vs 62.6%, P = 0.01) and tenosynovitis under ultrasound (79.3% vs 56.8%, P = 0.002) in the late onset group. Conclusions Late-onset PsA was associated with a later onset of PsO, slower progression to PsA, and a higher frequency of peripheral polyarthritis and bone erosion. Age of onset is of great value in revealing the phenotypes and prognosis of PsA.<Table Float="No" ID="Taba"> <tgroup cols="1"> <colspec align="left" colname="c1" colnum="1" /> <tbody> <row> <entry align="left" colname="c1"> Key Points </entry> </row> <row> <entry align="left" colname="c1"> • The age of onset plays a crucial role in the classification and prognosis of PsA. • The late onset of PsA is due to the delayed onset of PsO and the prolonged duration for PsO to progress into arthritis. • Late-onset PsA showed a greater tendency to develop bone erosion, particularly in peripheral joints, and to have comorbidities. </entry> </row> </tbody> </tgroup> </Table>

Gender, clinical phenotype and imaging features of patients with late-onset psoriatic arthritis

期刊论文
发表日期：

2025年5月30日

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Fangqing Wang,
Wenshe Wang,
Ranran Yao,
Wenhao Lin,
Siying Li,
Ru Li,
Yuan Jia

摘要

Objective

Psoriatic arthritis (PsA) is a chronic inflammatory disease affecting the musculoskeletal system. This study aimed to compare the gender, clinical and radiological characteristics between PsA patients with age of onset ≥ 50 years (late-onset) and patients with age of onset < 50 years (early-onset), and analyze the correlation between age onset and disease features.

Methods

A retrospective cohort study of 281 PsA patients from Peking University People’s Hospital (2014–2022) was conducted. Demographic, clinical, laboratory, imaging and treatment data were collected. Comparisons between groups were performed using Student’s t-test, Mann–Whitney U test and chi-square test. Logistic regression described the association between age of onset and disease characteristics.

Results

Among the 281 cases (207 early-onset vs74 late-onset), there were more female in the late-onset group and more male in the early-onset group (60.8% vs 39.2%, 53.1% vs 46.9%, P = 0.039). The onset of PsO was later (44.22 ± 3.79 vs 27.43 ± 1.45, P < 0.001) and duration from PsO to PsA was longer (17.39 ± 14.78 vs 8.37 ± 7.82, P < 0.05) in late-onset group. The late-onset group has a higher proportion of polyarthritis (66.7% vs 50.5%, P = 0.019) and comorbidities, but a lower proportion of psoriasis (89.2% vs 97.1%, P = 0.019). Besides, the late-onset patients presented higher levels of ESR, folate and tartaric acid phosphatase (trap-5b), but lower levels of hemoglobin and homocysteine. Imaging features revealed more frequent X-ray bone destruction (40.7% vs 25.3%, P = 0.033), synovitis (81.0% vs 62.6%, P = 0.01) and tenosynovitis under ultrasound (79.3% vs 56.8%, P = 0.002) in the late onset group.

Conclusions

Late-onset PsA was associated with a later onset of PsO, slower progression to PsA, and a higher frequency of peripheral polyarthritis and bone erosion. Age of onset is of great value in revealing the phenotypes and prognosis of PsA.

Key Points

• The age of onset plays a crucial role in the classification and prognosis of PsA.

• The late onset of PsA is due to the delayed onset of PsO and the prolonged duration for PsO to progress into arthritis.

• Late-onset PsA showed a greater tendency to develop bone erosion, particularly in peripheral joints, and to have comorbidities.